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Steve Steckler writes that “some single-payer or government option advocates are dismissing the need for competition.”

This is, I’m afraid, yet another example of a conservative purposefully mis-using terminology to confuse readers. As I am quite sure Mr. Steckler knows, in a “single-payer system” all health care bills are paid by one entity—the government. Canada and the UK are the only developed countries with single-payer healthcare.

A “single-payer system” is not interchangeable with “a government option” –which is what Steckler’s “or” suggests.

To the contrary, President Obama’s plan proposes having a government insurance option as an alternative to for-profit private insurance. Americans would be able to choose between the private insurance option (which is many cases would mean keeping the employer-based insurance that they have now) or signing up for a government insurance plan that some call “Medicare E” (Medicare for Everyone , which would be modeled on a reformed, improved Medicare.)

The president favors having this alternative to “give Americans choices, and to keep the private sector honest.”Medicare E would set high standards for what the private insurers competing for market share would have to offer in terms of comprehensive coverage and reasonable premiums, deductibles and co-pays.

Steckler asserts that Medicare is “currently driving reimbursements below cost and pushing an increasing number of providers to opt out of the system.” He offers no evidence for this assertion because it is, in fact, not true. While Medicaid (the program for the poor) reimburses providers less than it costs to provide care, Medicare’s reimbursements to many doctors and hospitals are, in fact, sufficient.

As the non-partisan Medicare Payment Advisory Commission (MedPac)has reported, many hospitals make a profit on Medicare reimbursements . Last week, I met Mark Kelley, the CEO of the Henry Ford Medical Center, and he told me that they turn a profit on Medicare payments. His is only one of a great many efficient hospitals that are able to do this. As MedPac points out, inefficient hospitals –hospitals that do a large number of redundant and unnecessary tests and procedures while reporting a large number of readmissions as well as infections and medical errors --are not able to make a profit on Medicare. Does this mean that Medicare should pay them more to reward them for their inefficiency?

Just one example of an efficient hospital: it costs Medicare 50 percent less when a patient is treated at the Mayo Clinic than when a very similar patient is treated at the UCLA Medical Center. (For evidence, see www.dartmouthatlas.org) Mayo gets the diagnosis right the first time and does many fewer tests and procedures. The patient sees many fewer specialists, spends less time in the hospital, and is much less likely to fall victim to a hospital error. Outcomes are better at Mayo as are patient satisfaction and doctor satisfaction.

When it comes to reimbursing doctors, both Medicare and MedPac have said that Medicare is paying some doctors too little, while paying other doctors too much. Primary care doctors, family practitioners, pediatricians, palliative care specialists and gerontologists are not paid enough. Meanwhle some specialists are paid too much for certain services. A quick example: in 2005 the Medicare fee for a typical 25- to 30-minute office visit to a primary care physician in Chicago was $89.64 for a patient with a complex medical condition (Current Procedural Terminology [CPT] code 99214). By contrast, Medicare’s fee for a gastroenterologist performing a colonoscopy (which also takes about 30 minutes) in his office was $422.90 for his thirty minutes. (These numbers come from an article in the June 2007 issue of the Annals of Internal Medicine.

This year, Medicare will be raising fees for primary care doctors; at the same time, it is likely to trim fees for certain over-priced services, particularly if there is no evidence that they are effective. A public-sector insurance plan would follow Medicare’s new fee schedule.

As for driving doctors out of Medicare—at present some Medicare patients report having a hard time finding a primary care physician taking new Medicare patients. (This is partially because of low fees, partially because we are suffering a primary care shortage nationwide. Even patients with private insurance have a hard time locating a primary care doctor.) Most specialists who took Medicare five years ago still take Medicare. In Manhattan, where I live, a great many Park Avenue specialists will see new Medicare patients.

A postscript: in case you are wondering why Medicaid pays so little: in 1965 Southern Congressmen told LBJ that they would not vote for the Medicare/Medicaid bill if doctors who cared for poor (often black) patieints on Medicaid were paid as much as doctors who cared for senior (largely white) patients. (At that time relatively few black Americans living in the South lived past 65.)

Why, one may ask, is Obama taking on yet another huge fight by taking aim at foreign tax havens? Yes, it's unfair that multinationals pay an average tax rate of only 2 percent on their foreign revenues, and it's unfair that some wealthy Americans are avoiding taxes altogether by parking their fortunes abroad. But, hey, these have been true for decades. So why take them on now, when the President is also taking on universal health insurance and global warming, and trying to get the economy going again?

The White House says that some jobs go abroad because American companies are lured there by tax loopholes which, if closed, would bring the jobs home. True. But a crackdown on tax havens might also cost American jobs if companies decided that a higher tax burden here required them to cut payrolls in order to stay competitive or to simply leave the United States altogether.

Another possible explanation is that it was a campaign promise. Obama frequently criticized the tax code for allowing American companies with overseas operations to defer paying taxes on corporate profits if they placed the money back into their foreign subsidiaries. But this can't be it, either. He criticized several other things as well -- such as the North American Free Trade Agreement -- which he now seems comfortable with.

So again: why this, and why now?

Two reasons, both strategic. The President needs the cooperation of many big corporations if he's going to get universal health insurance enacted this year. Many of these companies would benefit from lower health costs but they're reluctant to take on Big Pharma, big health insurance companies, and major health providers, all of whom are dead set against a provision in the emerging health insurance proposal that would allow the public to opt for a government health plan. How does it help for him to take on corporate tax havens? Because the President needs as many bargaining chips with the rest of corporate America as possible. The proposed crackdown on foreign tax avoidance is one such chip. He might be willing to take it off the table if big corporations lend him active support on health insurance.

The second reason has to do with revenues. Originally the White House had planned to pay for universal health insurance by limiting tax deductions for wealthier Americans. But the Democratic leadership nixed that source. The rich Americans who take the deductions, and the groups benefiting from the wealthy's tax-deductible expenditures on them, had enough political leverage to make it a non-starter. That means the White House has to find other sources of money.

By some measures, $700 billion or more in U.S. corporate earnings is now sitting in overseas accounts. A portion of that might be made available to help pay for universal health insurance. The Administration figures it could raise over $100 billion over ten years by preventing companies from taking immediate deductions for overseas expenses while deferring tax payments on profits there, and claiming inflated credit against American taxes for foreign taxes paid. It could raise another $95 billion by making it harder for individuals to hide their income in offshore accounts, and harder for companies to shift income from one foreign subsidiary to another in search of the lowest-tax jurisdiction.

The White House is preparing to release a more detailed budget blueprint later this week. That blueprint has to contain some credible ways to pay for universal health insurance. Otherwise the measure could become vulnerable to deficit hawks who, like vultures over road kill, continue to circle ominously.

In considering a potential nominee for a seat on the Supreme Court, there is no more important attribute than this: that he or she has read, understood, and at the very least been somewhat influenced by the constitution of the United States. One would think that would be a given, but it ain’t necessarily so.

There are those who think the constitution forbids the government from doing almost anything at all. Others would assign to the government a broad reach into almost every aspect of citizen life, based primarily on one's personal instincts as to what is good and right. Both positions are exaggerated because the Constitution provides for both empowerment and constraint: some things are out of bounds, but not everything is. It is the role of a Supreme Court justice, not being either a legislator or president, to square policy proposals with the constitutional framework; to permit that which the document allows and to strike down that which goes beyond its limits.

If all this seems obvious, let me point to the president's decision to appoint University of Chicago professor Cass Sunstein to be OMB's regulatory czar. Sunstein is not only a teacher; he is a teacher of constitutional law. He recently published a new book, "a constitution of many minds," in which he reveals an abysmal ignorance of the constitution's purpose and effect. He argues that in determining constitutionality -- a function the court has assumed since its long-ago decision in Marbury v Madison -- justices should consider three possible courses: to find constitutional that which comports with custom; to find constitutional that which reflects the popular opinion of the moment; or to find constitutional that which most closely parallels decisions in, say, France or Germany or Ecuador (he calls this a "cosmopolitan" method of interpretation). One would think that with Professor Sunstein's broad approach to interpretation he might have added a fourth possibility -- to rule according to the actual language of the constitution, at least where it speaks clearly. This he did not do.

There is no indication that Mr. Sunstein is one of the persons currently on president Obama’s short list to fill the court vacancy, but the fact that a man with such little understanding of the constitution and the court's role would win the plaudits of the president, and be assigned a significant role in the president's administration, does increase the importance of finding a man or woman well versed in the primary law of the nation. (In fairness, president George W. Bush wanted to put Harriet Miers on the court despite the fact that she may have understood the constitution even less well than Professor sunstein; insistence on recognition of the Constitution's boundaries and their significance is not a partisan matter).

Let the president nominate a man or a woman, a judge or a governor, a white or a member of a racial minority, a liberal or a conservative -- but let it be a nominee who sees it as the role of the court to ensure faithful adherence to constitutionality. Nothing more is required.

I was interested that in the course of the livechat, Governor Dean said that we ought to have a carbon tax to pay for health care. I support a carbon tax, but most of the people who do--including Vice President Al Gore--support refunding whatever gets collected through a payroll tax cut that is a dollar-for-dollar equivalent to the amount collected through a carbon tax. This makes sense; if we are going to implement a carbon tax, it will be to get rid of a negative externality--the excessive amounts of carbon in the atmosphere. We don't want to have to rely on the continued presence of a carbon tax to fund priorities, since if we do so, it will mean that we are not doing enough to curb carbon emissions through the tax.

However, to fund health care, Governor Dean's carbon tax proposal will not have any such offset, which means that he will have to depend on the continued existence of a negative externality in order to ensure that health care continues to get funded. This despite Governor Dean's statement that he wants to impose a carbon tax in part because he wants to improve the environment. If he succeeds, he will just cut off a major portion of health care funding.

This is a very confused position. The rumors are that when the Obama Administration searched for a Secretary of Health and Human Services candidate, they actively decided against Governor Dean. If so, that was a good call.

....A large part of the roadblock to comprehensive reform is our inability to get people to understand exactly what that means.

This is interesting how the Democratic Party's seemingly top two healthcare reform theorists - Daschle and Dean - are outsiders rather than Administration insiders. They appear more vocal and effective this way. "Theorists" since much of this is still very conceptual and constricted by a rather distracting left-v-right debate model.

It's difficult to envision any type of serious reform without a mass movement taking place - and that's not happening at the moment. Mass movement doesn't mean sudden see-the-light compromises between business, labor and healthcare advocates after companies see an opening to trim their bottom line. With talk of a public-private hybrid, corporations are angling for an economy of consultants and temps, or a freelance workforce where employers will no longer be responsible for healthcare.

Gov. Dean, however, is on the right practical track by arguing for an expanded and consolidated digital information network of healthcare institutions and practition
ers, large and small. That could be a more immediate solution, prior to the legislative fix. The only problem is getting to that point in a country that is ranked 15th in the world in terms of broadband speed and access.

A large part of the roadblock to comprehensive reform is our inability to get people to understand exactly what that means. For the most part, we're all anxious over economic concerns, which trump health concerns. It shouldn't, but it is what it is. Perhaps, if elected officials and policy experts can make clear and plainspoken linkages between the two topics, we might see progress. But, when Democrats talk of using complex "reconciliation" maneuvers for passage and Republicans can't escape the free market/no-tax zone, the conversation gets a bit muddled and esoteric. As policy wonks and political observers, we might understand it. But, wonder if Jane and Joe on the street or road understand it beyond the crisis of the moment?

...The question is not whether America should have a public health option - we already do - but who is included and how much coverage is provided

As we debate the path to universal health care, the private insurers should remember what happened the last time they fought to cut themselves in and cut the government out, and the public insurance advocates should look to forge alliances as effective as the veterans and military families who won that fight. A few weeks ago, when the Obama budget team presented an ill-advised proposal to outsource Veterans Administration health care, many were outraged that private insurers were quick to cut themselves in and cut the government out of the VA's core mission. Moreover, many were surprised at the move, because if anything, the push among many VSOs was about improving care and and insourcing national guard and military families, not outsourcing.

Luckily, after military families, veterans service organizations, and their allies rose up in protest, the plan to outsource VA care was dropped. Following that bipartisan affirmation of the VA system, the question is not whether America should have a public health option - we already do - but who is included and how much coverage is provided. If we were to combine the needs of our veterans with their service-related coverage plus basic coverage for their families as well as the larger civilian population, we would have the bargaining power to dramatically cut costs and improve competition. Obviously we would have different degrees of basic coverage - a cadillac for veterans and a chevy for civilians - but the overall effect would be enhanced care for all.

Democrats are crazy if they blow this once-in-a-lifetime opportunity for genuine health care reform

They must do it now when they have a President with a 61% approval rating and the leverage of budget reconciliation to overcome a Republican filibuster. One of the best ways to help our economy is to fix our broken health care system. Escalating health care costs are rising six times faster than wages and are undermining the competitiveness of American businesses. A bill with a public insurance option will contain costs and make coverage affordable for every American. Democrats won the hearts of generations of voters when they gave our country Social Security, Medicare and Medicaid. If the GOP thinks it has problems now think where their candidates will be when they oppose Democrats on this one!

In modern medicine, it's easy to get a thousand prescriptions but hard to get a single remedy,

... and the same can be said about our reductive health care debate: doctors versus bureaucrats, government versus patients, public versus private. We've so let our health care system wane that it's the 21st century version of the Civil War.

Some argue that we'll pit group against group, cure against a cure, but that's surely the system we have now. Health care for some, prayers for everyone else. Even optimists have to confess that the health care and health insurance situation in this country is nearing the point of imminent catastrophe. When you have the U.S. Chamber of Commerce--not known as a bastion of radical, socialist ideology-- post on the top of their webpage that the United States has the world's best health care but a wasteful and inefficient system for delivering that care" and that "five consecutive years of double-digit premium increases have hit the business community hard, especially small firms," then you know the time is ripe for major health care reform.

Meanwhile: Should we have started from scratch to develop a health care and health insurance industry in this country that brought more services to more people, our current system is not the one we'd have created. I mean you wouldn't go to a doctor's office where the plants have died. Furthermore, the stale boilerplate that a public health system would pit illness against illness, young against old, values against values, is a canard that's intellectually dishonest and meant to frighten the public into doing nothing. The only merit of that false choice in the debate is cowering around the status quo--that the broken system we have must be better than the imperfect system we might create. Frankly, than can-do-nothing attitude verges on the un- American.

And yet: there are nearly 50 million Americans without health insurance today. You can't have 50 million uninsured Americans and also have the greatest health care system in the world. It's an oxymoron with not just severe but life-threatening consequences. But, hey, what's a potential epidemic virus among 50 million friends?

Should we have a true pandemic on the scale of the influenza outbreak of the 20th century...well, the horses of our failed health care system will have long been out of the barn. And: Should we have a major terrorist attack in some localities, hospital care is already overtaxed and would struggle to handle the burden. That's for catastrophes. At the level of the quotidian, it's standard issue obesity, hyper tension, high blood pressure, heart disease, cancer.

But for the grace of God, and yet, heaven knows, whether it's terrorist attack or heart attack, we'll still be asking the injured whether or not they have insurance.

Without calling Obama's health care plan "socialist," it's still easy to find some unfortunate parallels to the party line at Karl Marx U

In my long-ago undergraduate days abroad, I spent some eye-opening time studying at the Karl Marx University of Economic Science in Budapest. The professors there welcomed the chance to regale their handful of American students with the flaws of free markets, including how wasteful competition is and how irrelevant choice becomes once the government has taken care of everyone's "true" needs. Then, after class, they would invite us to their apartments, pull down the window shades, turn up the music and whisper to us what they really thought.

Without calling Obama's health care plan "socialist," it's still easy to find some unfortunate parallels to the party line at Karl Marx U (since renamed for reasons worth remembering). The similarities lie in how some single-payer or government option advocates are dismissing the need for competition among health care insurers. Moreover, I know from experience in infrastructure services delivery that a "government option" is usually a euphemism for artificially equipping one competitor (the government) with house money, scale and self-serving accounting rules while the others (private insurers in this case) struggle to compete as true stand-alone financial entities.

The government option, like Medicare, would also have unequaled pricing power to set doctor and hospital reimbursements and premiums, and to do so on a political basis rather than cost. The same incentives in Medicare and Medicaid are currently driving reimbursements below cost and pushing an increasing number of providers to opt out of the system. Likewise, below-market -- if not below-fully-allocated-cost-- premiums can be expected to crush the private the insurance industry, if not immediately then eventually. In the minds of many single-payer and government options advocates, as it was in 1970's Hungary, such domination is precisely the idea.

We are very likely to have a budget deficit that is much higher than the one the Administration says that we will have

I am sorry that I didn't get a chance to ask Tom Daschle a question, though I greatly appreciate that Arena Imperator Barbash was able to procure an interview; the Q&A that he conducted was most informative. If I had the chance to ask questions of Senator Daschle, my question would have been about the President's statement in last week's press conference that we can supposedly get a vast amount of savings through the utilization of preventive care policies. No one, of course, has a problem with the concept of preventive care per se, but according to a fact check of the President's press conference, the New England Journal of Medicine stated during the campaign last year, "sweeping statements about the cost-saving potential of prevention . . . are overreaching," and that "although some preventive measures do save money, the vast majority reviewed in the health economics literature do not." Additionally, a study released in December by the Congressional Budget Office, states that increasing preventive care "could probably improve people's health but would probably generate either modest reductions in the overall costs of health care or increases in such spending within a 10-year budgetary timeframe."

Given that the Administration appears to have dramatically overstated the savings attendant to the implementation of preventive care, and given that the Rosy Scenario of GDP growth figures that are part of the President's budget will likely not be reached, we are very likely to have a budget deficit that is much higher than the one the Administration says that we will have. Doesn't this indicate that the Administration's health care plan is fundamentally flawed in that its implementation will seriously detract from our nation's fiscal health? And since one of the chief advocates of the "we will save gobs of money through preventive care" line is Senator Daschle's former speechwriter and the current OMB Director, Peter Orszag, who himself does not seem to have any firm idea of how much money can be saved, does Senator Daschle have any plans to take Director Orszag to the woodshed for promising more than just about anyone believes he can deliver in terms of savings through preventive care?

Tom Daschle gave healthcare reform a 50/50 shot at passage. I believe it is much less than that now (30/70 at best) given the Democrats have deployed reconciliation as a tool to force the issue, and how much healthcare reform ($1 trillion in start up) will cost.

Members on both sides of the aisle, particularly those in the Senate, warned about the dangers of maintaining health care reform within reconciliation. That it would kick off the effort on a sour and partisan note, and undermine approaches that have been produced on a bipartisan basis. Such goodwill has taken years to develop, and this collaboration will be lost once the direction of the package becomes too big, expensive and cumbersome -- even for some Democrats.

The process could also lead to a final health care reform product that is a disconnected mess because of decisions the Senate parliamentarian may choose to make with respect to whether certain parts of the package relate to government spending or revenue (or not). During the debate, a key issue will come down to whether those Americans who have access to health insurance -- and those being forced to pay for it -- will fear whether they have more to lose than to gain if Congress acts. That could easily be the case given the direction of where the health care reform discussion is headed with respect to the size, scope, costs and intrusiveness of the package.

There are 46 million Americans with no health insurance, but even if tomorrow, magically, we could provide an insurance card for every American, you still would have 60 million Americans with insurance but still unable to find a doctor or a dentist.

Tom Daschle touched on that in The Arena interview when Politico asked, “If you couldn't get everything, but you could get one thing, what would it be? His answer: “I'd say universal access.” Tom has written about the critical role that community health centers could play in providing access to primary health care for all Americans. “These clinics are a godsend for many people across the country, particularly those who live in rural areas with a shortage of health-care providers. Even if we achieve ‘universal’ coverage, there will be some percentage of people who still fall through the cracks,” he wrote in his book, Critical: What We Can Do about the Health Care Crisis.

As a nation, while we have an overabundance of high-paid specialists, we have a major shortage of primary health care physicians, dentists, nurses and other medical personnel. The result is not only that about 20,000 Americans a year die because of a lack of health care access, but costs soar as people who lack primary health care flock to expensive emergency rooms for their medical needs. Further, because people who lack access to a doctor often delay getting the medical treatment they need, they get even sicker and end up in a hospital.

That’s the bad news. The good news is that with a new administration and a new Congress understanding the need to substantially improve primary health care, we are beginning to make some real progress. In the recently-passed stimulus package, Congress doubled the amount of money going to community health centers and tripled the amount of money for the National Health Service Corps, which will substantially increase primary health care doctors, dentists and nurses.

Community health centers, created by the Federally Qualified Health Centers program, have been around for a long time. More than 40 years ago, Senator Edward Kennedy had the foresight to author legislation creating the community health centers. Today, support for this extremely cost-effective program cuts across party lines. The program was expanded under President George W. Bush, is strongly supported by President Barack Obama, and has widespread tri-partisan support in Congress.

Today, community health centers provide primary medical care to 18 million Americans in underserved rural areas and inner cities. Their doors are open to all, including patients with Medicare, Medicaid, private insurance, and those who have no insurance at all. Furthermore, the centers provide their services on a sliding-scale basis, meaning that those with low incomes receive discounts. No patient who walks into a community health center is turned away because he or she lacks payment.

While we have made significant progress in the last year in expanding community health centers and providing increased support for existing centers, much more has to be done.

I have introduced legislation -- The Access for All Americans Act – which would authorize $8.3 billion to expand the number of Federally Qualified Health Centers from 1,100 to 4,800. The legislation also would strengthen the National Health Service Corps by authorizing $1.2 billion. The nearly ten-fold increase would address a serious doctor, dentist and nursing shortage in the United States by expanding the effort to recruit and train health care professionals. Companion legislation in the House was introduced by Rep. James Clyburn.

If our legislation is passed, it will not only keep people healthy by providing medical and dental care and low-cost prescription drugs, it also will save billions of dollars by helping people stay healthy and stay out of hospitals and emergency rooms. Dan Hawkins, senior vice president of the National Association of Community Health Centers, testified at a hearing last week that the cost of care at health centers is 41 percent less than what is spent to care for patients elsewhere. That results in a savings of more than $17 billion a year today, he said. The savings could grow to more than $40 billion annually if health centers were expanded to serve more patients.

Our goal should be to make sure that every underserved area in America has a federally-funded community health center so that anyone in the area can receive high-quality health care, dental care, mental health counseling and low-cost prescription drugs.

In the richest country in the world, no American should have to go without basic health care. Community health centers are a critical lifeline for millions of Americans and we must build upon their success by expanding them to all those in need.

The goal of the health care plan under discussion is to force us all on to one government health care plan so the government can ration health care. If someone over the age of 65 needs an expensive procedure, they will be out of luck. Bureaucrats in Washington will decide what operations, medical procedures, and prescribed medicines you can buy instead of you and your doctor making those decisions. Any health care plan should be amended to include a patient’s bill of rights that guarantees every person a legal right without penalty in terms of losing their government plan health insurance to spend their own money on any doctor or otherwise legal health care procedure or medicine to supplement the government plan. Americans have a natural and inalienable right to hire a doctor with their own money or choose a health care procedure or medicine without fear of loosing their government mandated health insurance. Any law that is passed ought to reflect that fact, and if doesn’t the courts should hold it to be unconstitutional.

Our Quinnipiac polls have shown almost 100 percent agreement that health care must be fixed, and a down-the-middle political split over what that means. Republicans focus on cost. Democrats focus on the percentage of uninsured. President Obama's first task would appear to be to find things they might agree on -- catastrophic care, simplifcation of forms, stuff like that. Or he can decide to go for broke, ignore the Republicans and fashion a program his fellow Democrats will like. My guess is that, whatever he proposes, Congress will thoroughly chew it up. And on health care, as on the various bail-outs, one of these days, the bill will come due. That will give Politico plenty to write about.

One of the many reasons I don't like national health care is that it divides us. We have to decide - will we cover abortions and birth control? Decisions on what care people can receive become political. It becomes a political decision whether or not grandma can have a hip replacement, or whether that money is better spent on some stranger's drug rehab, or some other grandmother's cancer treatment, or a decision not to spend it on healhcare at all, but to use the money for something grandma doesn't give a damn about, such as funding National Public Radio. We get to vote on it. "Sorry you old bag, I'd rather listen to Marketplace." One underappreciated reason for the superiority of markets is that they allow freedom, diversity, and multi-culturalism to flourish. Some foolish people think of politics as a way in which the community comes together, but at least in the modern welfare state, it's merely the means by which some impose their vision of the good life on others, who have a different vision.

National health care is, among other things, one more small way in which Americans will be pitted against one another, our charitable impulses turned to rivalry, and our society made a bit meaner and a bit coarser.

If a public plan can provide quality care at a lower cost, then why not give people the choice?

The health insurance industry gives us yet another example, along with the banks, the insurance industry and the auto industry, of businesses that find themselves unable to compete in the market. In the case of the other three industries, the taxpayers have been asked to cough up hundreds of billions of dollars to keep firms in business that would have failed without government aid.

In the case of the health insurance industry, the firms in the sector are asking taxpayers to pay hundreds of billions of dollars in additional fees in coming decades rather than creating a lower cost public plan as an option. Remarkably, these millionaire and billionaire welfare dependents are the first to start crying about "socialism" when the government puts any conditions on their handouts.

If the health insurance industry is able to prevent the creation of a public plan option then it will be a testament to the incredible corruption of Congress. If a public plan can provide quality care at a lower cost, then why not give people the choice?

Howard Dean is right about the importance of health information technology for improving quality, reducing paperwork, preventing medical errors, and saving money. In my new book, Digital Medicine: Health Care in the Internet Era (Brookings Institution Press), I find that not many American doctors use electronic medical records. Comparative studies reveal that 59 percent of the health providers in the United Kingdom and 80 percent of those in New Zealand rely on electronic records, compared to 17 percent in the United States. America trails other countries in digital medicine because we have few agreed-upon standards for medical software, there is a divide in access to high-speed broadband for digital imaging, and implementation costs are borne almost solely by medical practices. The lack of national technology standards means 1,000 flowers have bloomed and few of the computer systems can talk with one another. We need digital systems with portable records for when people move or change jobs, ties to health outcomes, and reforms of reimbursement systems that encourage preventive care and quality outcomes.

Epidemic a perfect example of why public health infrastructure needs to be rebuilt

I applaud both Tom Daschle‘s and Howard Dean’s commitment to true health reform. Going forward, I hope that public health does not get forgotten. The current H1N1 epidemic (possibly a pandemic in the near future) is a perfect example of why neglected public health infrastructure needs to be rebuilt. We are in the process of doing so for vaccine R&D, and our work on preparing for H5N1 (bird flu) has been a boon, but there are many more aspects to prevention of disease, wellness and chronic disease management than just high tech investment in vaccine production and influenza research, important though it may be. At the federal level, and especially at the state level, public health should be supported with dollars and commitment.

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